Apathy in Alzheimer's disease: Contribution to a clinical view on progression of dementia

Stella, Florindo; Andrade, Larissa Pires de; Vital, Thays Martins; Coelho, Flávia Gomes de Melo; Nascimento, Carla Manuela Crispim; Hernández, Salma Stéphany Soleman

doi:10.1590/s1980-57642010dn40300007

Cited by 6 publications

(4 citation statements)

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“…The AES D16 -I and MMSE scores appeared to be completely independent of one another and the correlation between the AES D16 -I and GDS was only globally significant and modest. When using the same combination of measures, Stella et al (2010) found moderate correlations of the AES scores with the MMSE and GDS scores in a sample of 15 persons with mild to severe Alzheimer’s disease, whereas Thomas et al (2001) report a low correlation of AES and MMSE scores in a sample of 132 persons with mild to severe Alzheimer’s disease, but no significant correlation in their control group. As Ishii, Weintraub, and Mervis (2009) point out, inconsistent findings with regard to this question may be the result of differences in the inclusion criteria, methodologies, instruments, and diagnostic criteria of apathy.…”

Section: Discussionmentioning

confidence: 90%

“…With respect to the clinical correlates of apathy in dementia, a large body of evidence indicates a strong relationship between apathy and cognitive and global impairment (Diehl-Schmid, Pohl, Perneczky, Förstl, & Kurz, 2006; di Iulio et al, 2010; Fernandez-Martinez, Molano, Castro, & Zarranz, 2010; Okura et al, 2010; Poletti et al, 2013; Savva et al, 2009; Starkstein, Jorge, Mizrahi, & Robinson, 2006; Stella et al, 2010; Zuidema, de Jonghe, Verhey, & Koopmans, 2009), whereas some studies suggest that apathy and cognitive impairment are independent of each other (D’Onofrio et al, 2012; Horning, Melrose, & Sultzer, 2014; Palmer et al, 2011; Vilalta-Franch, Calvó-Perxas, Garre-Olmo, Turró-Garriga, & López-Pousa, 2013; Zawacki et al, 2002). Apathy and instrumental and basic activities of daily living (ADLs) were repeatedly shown to be negatively associated (Boyle et al, 2003; D’Onofrio et al, 2012; Helvik, Engedal, Benth, & Selbæk, 2014; Rog et al, 2014; Starkstein et al, 2006; Vilalta-Franch et al, 2013; Wadsworth et al, 2012; Zawacki et al, 2002).…”

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confidence: 99%

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Apathy in Dementia Care

et al. 2016

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Abstract. Apathy is a diminished goal-directed behavior stemming from a lack of motivation. It is one of the most common symptoms in dementia. While the Apathy Evaluation Scale (AES) has proved to be a psychometrically robust measure for assessing apathy, the German version (AESD) requires further validation. Associations of apathy with important variables in dementia care, such as cognitive impairment or caregiver burden, were repeatedly found, though contradictory findings have also been reported. The present study assessed apathy in 100 community-dwelling persons with dementia. Their informal and formal caregivers used the German informant version of the Apathy Evaluation Scale (AESD-I) to investigate the severity of dementia and cognitive deficits as measured with the Mini-Mental State Examination (MMSE) and Global Deterioration Scale (GDS), respectively. A reliability analysis was performed to estimate the internal consistency of the AESD-I, and the data were tested for potential correlations with results from a shortened version of the AESD-I (AESD16-I). Cronbach’s α was .880 for the AESD-I and .904 for the AESD16-I. The prevalence of apathy was 77%, its severity was on average moderate to high. Significant (p < .05) negative correlations were shown between the AESD16-I, the Barthel Index (BI), and the Quality of Life-Alzheimer’s Disease (QOL-AD). Correlations between the AESD16-I, GDS, and Zarit Burden Interview were positive. After Bonferroni correction, the only correlations that remained significant were between the AESD16-I and BI and QOL-AD. The present study underlines the favorable psychometric properties of the AESD-I and confirms the high prevalence of apathy with considerable severity in the sample of community-dwelling persons with dementia. In addition, it contributes to the diversity of evidence on clinical correlates of apathy which require further clarification.

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Section: Discussionmentioning

confidence: 90%

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confidence: 99%

Apathy in Dementia Care

et al. 2016

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“…As mentioned above, MMSE scores did not correlate with AS scores, unlike a previous work reporting that Apathy Evaluation Scale was associated with MMSE scores in patients with AD. 39 Although this previous study covered mild, moderate and severe patients with AD, 39 the subjects included in the present study were mainly patients with early-stage AD spectrum with relatively high MMSE and low GDS scores in a narrow range. Therefore, these distinct clinical stages covered by the two studies may partially explain the somewhat discrepant results.…”

Section: Discussionmentioning

confidence: 98%

Tau-induced focal neurotoxicity and network disruption related to apathy in Alzheimer’s disease

Kitamura

Shimada

Niwa

et al. 2018

J Neurol Neurosurg Psychiatry

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ObjectiveApathy is a common neuropsychological symptom in Alzheimer’s disease (AD), and previous studies demonstrated that neuronal loss and network disruption in some brain regions play pivotal roles in the pathogenesis of apathy. However, contributions of tau and amyloid-β (Aβ) depositions, pathological hallmarks of AD, to the manifestation of apathy remain elusive.MethodsSeventeen patients with AD underwent positron emission tomography (PET) with 11C-pyridinyl-butadienyl-benzothiazole 3 (11C-PBB3) and 11C-Pittsburgh compound-B (11C-PiB) to estimate tau and Aβ accumulations using standardised uptake value ratio (SUVR) images. 11C-PBB3 and 11C-PiB SUVR were compared between AD patients with high and low Apathy Scale (AS) scores. Additionally, volumetric and diffusion tensor MRI was performed in those areas where any significant difference was observed in PET analyses. Correlation and path analyses among AS and estimated imaging parameters were also conducted.ResultsAD patients with high AS scores showed higher 11C-PBB3 SUVR in the orbitofrontal cortex (OFC) than those with low AS scores, while 11C-PiB SUVR in any brain regions did not differ between them. Elevated 11C-PBB3 SUVR in OFC, decreased OFC thickness and decreased fractional anisotropy (FA) in the uncinate fasciculus (UNC), which is structurally connected to OFC, correlated significantly with increased scores of the AS. Path analysis indicated that increased 11C-PBB3 SUVR in OFC affects apathy directly and through reduction of OFC thickness and subsequent decrease of FA in UNC.ConclusionsThe present findings suggested that tau pathology in OFC may provoke focal neurotoxicity in OFC and the following disruption of the OFC-UNC network, leading to the emergence and progression of apathy in AD.

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“…La apatía y sus consecuencias funcionales se cuentan entre las principales causas de discapacidad y estrés del cuidador por las enfermedades neuropsiquiátricas y psiquiátricas [1][2][3][4][5] . Pese a que la apatía está incorporada a la medicina y la psiquiatría desde el siglo xix, siguen existiendo dificultades para una definición y una conceptualización adecuadas 6 .…”

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